Three-year epidemiology of hospitalised paediatric burn patients in a Malaysian Tertiary Hospital 2016 - 2018

INTRODUCTION

Burn injuries incur not just significant morbidity but also long-term psychosocial impact. This study aims to identify the clinico-demographics of children hospitalised for burns and factors associated with prolonged hospitalisation.

MATERIALS AND METHODS

Written medical records of burn patients admitted to the Sultanah Aminah Hospital paediatric surgical ward, from January 2016 to December 2018, were retrospectively reviewed. Details on the patients' socio-demographic background, burn injuries, management and outcomes were recorded and analysed with logistic regression.

RESULTS AND CONCLUSION

Of the 255 children included in the study, the majority were males (62.7%), children aged between 1 to 3 years (43.1%), and of the Malay ethnic group (83.1%). The commonest injury mechanism was scalds burns (81.2%). Staphylococcus aureus remained the commonest organism cultured from paediatric burn wounds. Most patients (66.4%) were hospitalised for less than 1 week. A significant number of patients experienced complications from their injuries. Multivariate analysis showed burns affecting total body surface area > 10% (adjusted OR, 13.45 [95% CI 6.25 - 28.96]; p = < 0.001) and non-scald burns (adjusted OR, 2.70 [95% CI 1.12 - 6.50]; p = 0.027) were the two main factors associated with prolonged hospitalisation of more than 1 week. These findings describing the epidemiology and outcomes of paediatric burn cases in a tertiary centre in Malaysia may inform future practice. More importantly, the information may contribute to the identification of at-risk populations and advise the development of effective prevention strategies to reduce the incidence and morbidity associated with paediatric burns in this region.

A web-based educational intervention module to improve knowledge and attitudes towards thalassaemia prevention in Malaysian young adults

BACKGROUND

Thalassaemia is a public health burden in Malaysia and its prevention faces many challenges. In this study, we aimed to assess the effectiveness of a web-based educational module in improving knowledge and attitudes about thalassaemia prevention amongst Malaysian young adults.

METHODS

We designed an interactive web-based educational module in the Malay language wherein videos were combined with text and pictorial visual cues. Malaysians aged 18-40 years old who underwent the module had their knowledge and attitudes assessed at baseline, post-intervention and at 6-month follow-up using a selfadministered validated questionnaire.

RESULTS

Sixty-five participants: 47 Malays (72.3%), 15 Chinese (23.1%), three Indians (4.6%) underwent the module. Questionnaires were completed at baseline (n=65), postintervention (n=65) and at 6-month follow-up (n=60). Out of a total knowledge score of 21, significant changes were recorded across three time-points- median scores were 12 at pre-intervention, 19 at post-intervention and 16 at 6-month follow-up (p<0.001). Post-hoc testing comparing preintervention and 6-month follow-up scores showed significant retention of knowledge (p<0.001). Compared to baseline, attitudes at 6-month follow-up showed an increased acceptance for "marriage avoidance between carriers" (pre-intervention 20%, 6-month follow-up 48.3%, p<0.001) and "prenatal diagnosis" (pre-intervention 73.8%, 6-month follow-up 86.2%, p=0.008). Acceptance for selective termination however, remained low without significant change (pre-intervention 6.2%, 6-month follow-up 16.7%, p=0.109).

CONCLUSION

A web-based educational module appears effective in improving knowledge and attitudes towards thalassaemia prevention and its incorporation in thalassaemia prevention programs is potentially useful in Malaysia and countries with a high internet penetration rate.

Skill validation study on sentinel lymph node biopsy in breast cancer and the challenges of false-negative, in-transit and micrometastatic nodes

No abstract available.

Clinico-epidemiological profile, including body mass index of Malaysian children with psoriasis

BACKGROUND

Limited information exists regarding paediatric psoriasis and its association with body mass index (bMI) in Asia.

OBJECTIVES

to determine the clinico-epidemiological profile and to compare the bMI of children with and without psoriasis.

METHODS

A case-control study of 92 children with psoriasis versus 59 with atopic eczema and 56 with non-inflammatory skin conditions.

RESULTS

Psoriasis was more common in Malay and Indian children when compared to Chinese with odds ratios (Or) of 4.30 (95% CI, 1.85-9.99) and 3.00 (95% CI, 1.02-8.81) respectively. Prevalence of psoriasis was similar between Malay and Indian children (Or 1.43, 95% CI, 0.63-3.25). Male:female ratio was 1:1.09. the mean onset age of psoriasis was 7.9 years. Median onset age was earlier in males (6.5 years versus 9.0 years in females, p=0.05). Plaque psoriasis was the most common phenotype (89.1%) and 94.5% had scalp lesions. Arthritis was seen in 4.3%. Odds of excess adiposity, defined as bMI ≤85th percentile, was higher in children with psoriasis versus noninflammatory controls (Or 2.35, 95% CI 0.99-5.56, p= 0.052). No increased risk of adiposity was noted between children with psoriasis and eczema (Or 1.14, 95% CI 0.5-2.62, p=0.753). More children with psoriasis (17.4%) and eczema (20.3%) were underweight (bMI <5th percentile) compared to non-inflammatory controls (10.7%).

CONCLUSION

Malays and Indians are three to four times more likely than Chinese to have psoriasis in multi-ethnic Malaysia. Plaque psoriasis is the most common phenotype. Odds of excess adiposity is about two times higher in children with psoriasis compared to non-inflammatory controls although this observation just missed conventional statistical significance.

Teaching medical students neonatal resuscitation: knowledge gained and retained from a brief simulation-based training workshop

CONTEXT

Despite being an essential clinical skill, many junior doctors feel unprepared to perform neonatal resuscitation. We introduced a neonatal resuscitation training workshop in 2009 for our final-year medical students.

OBJECTIVES

We assessed the effectiveness of our workshop in improving knowledge immediately post-training and at the end of the year.

METHODS

We retrospectively analysed the data of our students who attended the workshops during their Paediatric posting in small groups. The workshop was adapted from the American Academy of Paediatrics (AAP) Neonatal Resuscitation Provider (NRP) programme, and included overview lectures, practical simulation, interactive video scenarios and assessments (pre- and post-tests), which comprised 21 multiple-choice questions covering evaluation, practical actions and theory. We repeated the assessment in the final week of the students' medical training ("final test"). We analysed the data using paired t-test, analysis of variance (ANOVA), linear regression and Friedman's test.

FINDINGS

All 56 students attended the workshops. Their mean scores (out of 21) were 11.7 (SD 2.5) (pre-test), 16.2 (SD 1.9) (post-test) and 13.6 (SD 2.3) (final test) (P ≤ 0.001 for all pair-wise comparisons). The workshop's timing (earlier or later in the year) had no relationship with the students' final test scores (P = 0.96). In the final test, 68.5%, 67.4% and 60.6% on average answered correctly questions on practical action, theory and evaluation, respectively (P = 0.03).

DISCUSSION AND CONCLUSIONS

Our workshop produced a modest gain in student knowledge on neonatal resuscitation at the end of their medical course. The students' overall gain in knowledge was below our expectation, and evaluation appeared to be their weakest domain. Further research should evaluate strategies to enhance longer-term knowledge retention with practical performance.

Familial complex chromosomal rearrangement in a dysmorphic child with global developmental delay

We report the unusual case of a dysmorphic child with global developmental delay secondary to a familial complex chromosomal rearrangement (CCR). His chromosomal analysis using G-banding and dual colour fluorescence in situ hybridisation with whole chromosome paint revealed a supernumerary marker chromosome as a result of malsegregation of a familial CCR involving chromosomes 7, 12 and 14. The balanced form of this familial CCR was also carried by the patient's mother and maternal grandmother, both of whom had a history of recurrent spontaneous abortions, as well as his maternal uncle, who was infertile. To the best of our knowledge, this is the first reported case of familial CCR involving chromosomes 7, 12 and 14. This case also highlights the importance of chromosomal analysis in children with dysmorphism and developmental delay as well as in adults who suffer from recurrent spontaneous abortions or infertility.